GMS COMPREHENSIVE FINAL EXAM PRACTICE EXAM
| STUDY GUIDE | TESTBANK | LATEST UPDATE
2026/2027 | QUESTIONS | 100% CORRECT ANSWERS
## Table of Contents
Patient Assessment and Clinical Decision-Making
Primary Care and Family Medicine
Emergency and Acute Medical Care
Cardiovascular Disorders
Respiratory Disorders
Endocrine and Metabolic Disorders
Infectious Diseases
Gastrointestinal Disorders
Neurology
Renal and Genitourinary Disorders
Pharmacology and Prescribing
Preventive Medicine and Public Health
Medical Ethics, Professionalism, and Patient Safety
Introduction
This practice examination is designed to assess comprehensive knowledge expected
of candidates preparing for a General Medical Services (GMS) comprehensive final
examination. The questions integrate clinical reasoning, diagnostic interpretation,
evidence-based management, preventive medicine, pharmacology, ethics, patient
safety, and professional judgment. Candidates should expect realistic clinical
scenarios requiring careful analysis rather than simple recall of facts. Coverage
reflects current best practices and contemporary standards applicable for the
2026/2027 academic period. Success requires integrating pathophysiology, clinical
guidelines, patient-centered care, risk assessment, and multidisciplinary decision-
making while recognizing appropriate investigations, treatment priorities, and
situations requiring urgent referral or escalation of care.
,Question 1
A 67-year-old man presents with crushing retrosternal chest pain for 45 minutes.
ECG demonstrates ST-segment elevation in leads II, III, and aVF. The nearest PCI-
capable center can perform intervention within 75 minutes. What is the most
appropriate immediate management?
A. Begin aspirin and schedule outpatient angiography
B. Administer fibrinolytic therapy immediately without referral
C. Activate the PCI pathway while administering dual antiplatelet therapy and
anticoagulation
D. Observe until cardiac biomarkers become available
Correct Answer: C
Explanation: Primary PCI within the recommended treatment window is preferred
for STEMI. Initial medical therapy should accompany urgent reperfusion.
Question 2
A patient with poorly controlled type 2 diabetes develops fever, hypotension,
confusion, and tachycardia. Serum lactate is elevated. Which intervention should
occur first?
A. Obtain MRI of the suspected infection site
B. Administer broad-spectrum intravenous antibiotics after obtaining cultures if this
does not significantly delay treatment
C. Begin insulin infusion only
D. Delay treatment until culture results are available
Correct Answer: B
, Explanation: Early recognition of sepsis requires prompt antimicrobial therapy
and source control. Cultures should not substantially delay antibiotics.
Question 3
A 34-year-old woman develops sudden unilateral leg swelling two weeks after
surgery. Which investigation best confirms the suspected diagnosis?
A. Plain radiograph
B. Venous duplex ultrasonography
C. CT abdomen only
D. Bone scan
Correct Answer: B
Explanation: Compression duplex ultrasonography is the preferred initial
diagnostic test for suspected lower-extremity deep vein thrombosis.
Question 4
A patient with hypertension has persistent blood pressure readings averaging
168/102 mmHg despite adherence to three antihypertensive agents including a
diuretic. What should be the next priority?
A. Discontinue all medications
B. Evaluate for secondary causes and medication adherence while optimizing
therapy
C. Ignore elevated readings because home monitoring is unreliable
D. Recommend exercise only
, Correct Answer: B
Explanation: Resistant hypertension warrants evaluation for secondary causes,
confirmation of adherence, and optimization of treatment.
Question 5
A patient presents with sudden facial droop, arm weakness, and aphasia beginning
90 minutes earlier. Initial CT excludes intracranial hemorrhage. What is the next best
step?
A. Delay therapy for repeat imaging tomorrow
B. Consider reperfusion therapy after confirming eligibility
C. Prescribe aspirin only and discharge
D. Begin corticosteroids
Correct Answer: B
Explanation: Eligible patients with acute ischemic stroke benefit from timely
reperfusion therapy within established treatment windows.
Question 6
A 72-year-old smoker has worsening dyspnea and productive cough. Arterial blood
gas reveals respiratory acidosis. Which finding most strongly supports acute
exacerbation of COPD?
A. Hyperinflation with wheezing and increased sputum production
B. Diffuse maculopapular rash
C. Isolated abdominal tenderness
| STUDY GUIDE | TESTBANK | LATEST UPDATE
2026/2027 | QUESTIONS | 100% CORRECT ANSWERS
## Table of Contents
Patient Assessment and Clinical Decision-Making
Primary Care and Family Medicine
Emergency and Acute Medical Care
Cardiovascular Disorders
Respiratory Disorders
Endocrine and Metabolic Disorders
Infectious Diseases
Gastrointestinal Disorders
Neurology
Renal and Genitourinary Disorders
Pharmacology and Prescribing
Preventive Medicine and Public Health
Medical Ethics, Professionalism, and Patient Safety
Introduction
This practice examination is designed to assess comprehensive knowledge expected
of candidates preparing for a General Medical Services (GMS) comprehensive final
examination. The questions integrate clinical reasoning, diagnostic interpretation,
evidence-based management, preventive medicine, pharmacology, ethics, patient
safety, and professional judgment. Candidates should expect realistic clinical
scenarios requiring careful analysis rather than simple recall of facts. Coverage
reflects current best practices and contemporary standards applicable for the
2026/2027 academic period. Success requires integrating pathophysiology, clinical
guidelines, patient-centered care, risk assessment, and multidisciplinary decision-
making while recognizing appropriate investigations, treatment priorities, and
situations requiring urgent referral or escalation of care.
,Question 1
A 67-year-old man presents with crushing retrosternal chest pain for 45 minutes.
ECG demonstrates ST-segment elevation in leads II, III, and aVF. The nearest PCI-
capable center can perform intervention within 75 minutes. What is the most
appropriate immediate management?
A. Begin aspirin and schedule outpatient angiography
B. Administer fibrinolytic therapy immediately without referral
C. Activate the PCI pathway while administering dual antiplatelet therapy and
anticoagulation
D. Observe until cardiac biomarkers become available
Correct Answer: C
Explanation: Primary PCI within the recommended treatment window is preferred
for STEMI. Initial medical therapy should accompany urgent reperfusion.
Question 2
A patient with poorly controlled type 2 diabetes develops fever, hypotension,
confusion, and tachycardia. Serum lactate is elevated. Which intervention should
occur first?
A. Obtain MRI of the suspected infection site
B. Administer broad-spectrum intravenous antibiotics after obtaining cultures if this
does not significantly delay treatment
C. Begin insulin infusion only
D. Delay treatment until culture results are available
Correct Answer: B
, Explanation: Early recognition of sepsis requires prompt antimicrobial therapy
and source control. Cultures should not substantially delay antibiotics.
Question 3
A 34-year-old woman develops sudden unilateral leg swelling two weeks after
surgery. Which investigation best confirms the suspected diagnosis?
A. Plain radiograph
B. Venous duplex ultrasonography
C. CT abdomen only
D. Bone scan
Correct Answer: B
Explanation: Compression duplex ultrasonography is the preferred initial
diagnostic test for suspected lower-extremity deep vein thrombosis.
Question 4
A patient with hypertension has persistent blood pressure readings averaging
168/102 mmHg despite adherence to three antihypertensive agents including a
diuretic. What should be the next priority?
A. Discontinue all medications
B. Evaluate for secondary causes and medication adherence while optimizing
therapy
C. Ignore elevated readings because home monitoring is unreliable
D. Recommend exercise only
, Correct Answer: B
Explanation: Resistant hypertension warrants evaluation for secondary causes,
confirmation of adherence, and optimization of treatment.
Question 5
A patient presents with sudden facial droop, arm weakness, and aphasia beginning
90 minutes earlier. Initial CT excludes intracranial hemorrhage. What is the next best
step?
A. Delay therapy for repeat imaging tomorrow
B. Consider reperfusion therapy after confirming eligibility
C. Prescribe aspirin only and discharge
D. Begin corticosteroids
Correct Answer: B
Explanation: Eligible patients with acute ischemic stroke benefit from timely
reperfusion therapy within established treatment windows.
Question 6
A 72-year-old smoker has worsening dyspnea and productive cough. Arterial blood
gas reveals respiratory acidosis. Which finding most strongly supports acute
exacerbation of COPD?
A. Hyperinflation with wheezing and increased sputum production
B. Diffuse maculopapular rash
C. Isolated abdominal tenderness
